| National Provider Identifier [NPI]: | 1215976808 |
| Last Name Of The Provider | GOLDSTEIN |
| First Name Of The Provider | LARRY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1044 N FRANCISCO AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606222743 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 8338 |
| Number Of Medicare Beneficiaries | 4316 |
| Total Submitted Charge Amount | 444541 |
| Total Medicare Allowed Amount | 149480.07 |
| Total Medicare Payment Amount | 120615.33 |
| Total Medicare Standardized Payment Amount | 110652.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 8338 |
| Number Of Medicare Beneficiaries With Medical Services | 4316 |
| Total Medical Submitted Charge Amount | 444541 |
| Total Medical Medicare Allowed Amount | 149480.07 |
| Total Medical Medicare Payment Amount | 120615.33 |
| Total Medical Medicare Standardized Payment Amount | 110652.45 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 258 |
| Number Of Beneficiaries Age 65 to 74 | 1978 |
| Number Of Beneficiaries Age 75 to 84 | 1460 |
| Number Of Beneficiaries Age Greater 84 | 620 |
| Number Of Female Beneficiaries | 3409 |
| Number Of Male Beneficiaries | 907 |
| Number Of Non Hispanic White Beneficiaries | 3720 |
| Number Of Black or African American Beneficiaries | 200 |
| Number Of AsianPacific Islander Beneficiaries | 180 |
| Number Of Hispanic Beneficiaries | 125 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3849 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 467 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.056 |